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Mentions: The conventional 128 Hz tuning fork test is an easy and inexpensive tool to assess vibratory sensation. The tuning fork is held over bony prominences such as the first metatarsal head and the lateral malleolus (Figure 2), and the test is considered positive when the patient is unable to perceive any vibration that the examiner can perceive (Singh et al 2005). The 5.07/10 g Semmes Weinstein monofilament consists of a plastic handle supporting a nylon filament (Figure 3) and is one of the most frequently utilized screening tools to identify loss of protective sensation in the United States (Armstrong 2000; Singh et al 2005). Testing via the Semmes Weinstein monofilament is administrated with the patient sitting supine in the examination chair with both feet level. The monofilament is applied perpendicular to the skin until it bends or buckles from the pressure, left in place for approximately one second and then released (Singh et al 2005). The patient with his or her eyes closed responds “yes” each time he or she perceives the application of the monofilament.
Foot ulcers in the diabetic patient, prevention and treatment
Bottom Line: Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care.Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced wound healing modalities in the treatment of diabetic foot ulcers.Early recognition of the etiological factors along with prompt management of diabetic foot ulcers is essential for successful outcome.
Affiliation: Center for Lower Extremity Ambulatory Research, William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, Chicago, IL 60048, USA.
Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order to diminish the detrimental consequences associated with diabetic foot ulcers, a common-sense-based treatment approach must be implemented. Many of the etiological factors contributing to the formation of diabetic foot ulceration may be identified using simple, inexpensive equipment in a clinical setting. Prevention of diabetic foot ulcers can be accomplished in a primary care setting with a brief history and screening for loss of protective sensation via the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy, plantar foot pressure, and assess vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, may enable clinicians to stratify patients based on risk and help determine the type of intervention. Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care. Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced wound healing modalities in the treatment of diabetic foot ulcers. However, it is imperative to remember the fundamental basics in the healing of diabetic foot ulcers: adequate perfusion, debridement, infection control, and pressure mitigation. Early recognition of the etiological factors along with prompt management of diabetic foot ulcers is essential for successful outcome.
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